"LOS CULPABLES DE LA MISERIA": POVERTY AND PUBLIC HEALTH DURING THE SPANISH INFLUENZA EPIDEMIC IN CHILE, 1918-1920

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Author

Maureira, Hugo Alberto

Abstract

During the Spanish influenza global pandemic, of 1918-1920, tens of thousands of people died in Chile. From the moment that the first cases appeared in Chile, in late September 1918, Chilean physicians argued over the nature and cause of the outbreak. Some argued that it was not Spanish influenza, but epidemic typhus. This study chronicles the events and impact of Spanish influenza on Chile. It also examines the country's public health response as it targeted the working-class and poor. In some cases the response was brutal. In Parral and Concepción, the Brigadas Sanitarias forcibly evicted thousands of people and burned down their homes. The historical record strongly suggests that Chile was struck by Spanish influenza, not a typhus epidemic. Yet, typhus served as a convenient diagnosis for physicians at the time. It fit a certain profile that Chileans had of their country. As a disease, typhus normally affects societies on the verge of collapse. By October 1918, the era of "Chilean exceptionalism," which had begun at the end of the War of the Pacific and the start of the Nitrate Boom, was coming to an end. Various social, economic, and political events made Chileans question the exceptionalism narrative and led them to proclaim "moral crisis," "economic inferiority," and national decline. When the mysterious symptoms of disease arrived in Chile, in 1918, it was easy for politicians and physicians to proclaim that it was typhus notwithstanding that, in the rest of the world, the disease was recognized to be Spanish influenza. For Chilean physicians and politicians, the country was in a state of decline.

This misdiagnosis had a profound effect on Chile: it led to a stigmatization of working-class people for decades to come; it drew needed attention to the plight of the working-class and their abysmal living conditions; and it intensified calls for social reform which led to the election of Arturo Alessandri in 1920.

Privacy concerns by providers have been a barrier to disclosing patient information for public health purposes. This is the case even for mandated notifiable disease reporting. In the context of a pandemic it has been ...